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You are still perpetuating the myth that the AHA guidelines are calling for stress testing within 72 hrs for all low risk patients with a negative work up. You state this in the segment, and even in the segment summary you write, "The official recommendations from the ACC/AHA guidelines still state that even low risk patients with chest pain should receive provocative testing or CT within 72 hours and preferably within 24 hours. "

Fortunately, this is not how the 2014 guidelines read, and although some of this is just semantics, these are important semantics. What the guidelines actually state:

It is reasonable for patients with possible ACS who have normal serial ECGs and cardiac troponins to have a treadmill ECG (200-202) (Level of Evidence: A), stress myocardial perfusion imaging (200), or stress echocardiography (203, 204) before discharge or within 72 hours after discharge. (Level of Evidence: B)

"It is reasonable for patients...to have" sounds to me a lot different than "patients must receive..."So, if you order such testing, no one from the AHA will call you unreasonable. The flip side however, of whether or not it may also be reasonable to skip these tests in low risk patients, really isn't discussed.

David GlaserDenver

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